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FOR OF II;E l{SE: ...iEr' Permit No. ..�'' tfl.. APPLICATION FOR SANITATION PERMIT ............................. ............ (Complete in Duplicate) Date Issued l3J --------------------------------------------------- This Permit Expires 1 Year From Date Issued 1 q3- 4o—L/ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 1401---fit 4 O'ell -- ?.S'o..s; .t-1G(Gr LOC `JOB ADDRESS AND LOC TIONr y—.......5....I�lG1C..1-rS -7----f'' � - -------------------------------------------....E.�.........L./.. Owner's Name----`.-�L °-s. .Q........1...-.s� ---------..__- - - ------------ ------- one .....---....wL.e��"� c� p / Phi / Addres,06MZ&-V - E ------- ................-----�E� Contractor's .....---•---....... Phone. --.�./. .. Installation will serve: Residence ❑ Apartment House ommercia1 ❑ Irailer Court ❑ M`//otel ❑ Other Number of living units: ----- . Number of bedroom . .... Number of baths . Lot size ...7K I .lZ.l�......7C�7�._f.••----•-•- Water Supply: Public system ❑ Community system ❑ `Private 'Depth ate; Table ........ #. Character of soil to a depth of 3 feet: Sand GVvel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ ' Previous Application Made: (If yes,date.. sC� ---I .No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ PWF OF INSTALLATION AND SPECIFICATIONS:f " (No septic tank or cesspool permitted if public sewer is available within 200 feet.) iE Distance from nearest well.................Distance from foundation--------------------Material:...........:................................. 1 No. of compartments-- -------------------Size..._....------.................Liquid depth.................--------Capacity....................... sql Distance from nearest well. , i-O. ...Distance from foundatign..A....0..*-Distance to nearest lot ling. f.O.r d Number of lines...e4-,..- r Length of each line..- ...........�.-- Width of trench . �r..T Type of filter metenal�F .. Depth/5._-. of filter matenal_.-L.B.......-----Total length...... �.....f_r................ O Seepage Pit: Distance to nearest well..-------.'-------._Distance from foundation....................Distance to nearest lot line................. L/ ❑ Number of pits......................Lining material....----•-.........._.Size: Diameter----------- Depilt................................. Cesspool: Distance from nearest well.................Distance from foundation....................Lining material_-.................................. ❑ Size: Diameter.......................................Depth......----------... ----------........---........Liquid Capacity-------........I.....-...gals. Privy: Distance from nearest well.........................................A......Distance from nearest building_............._.............. -----..-..... ❑ Distance to neare t lot " e......................................-'........----•---------------•-'............__..............--......-.........------------------ ` ----• Remodeling and/or repairing (describe):... .. ..... ••--- --------------------------------------------------------------- .... ...C�:C�.l ---------------------------------------------•------------------------- -------------------.....------------------------------------•---------------------------------------*...--- .................... ......................-------------.........--------=----------------------------------------- ------ ----------------------..................................................... hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, �SStj�a/} 1 laws, and rules anrdJregons of thaquin Lo I Health District. I�( � -- c x "�c.�........- - - ..-(6wrr Contractor) ........ By:.....:............- - -- -------- ----(Tithe)------- ---------- -- - .. _.__...........__ .. - ---------------------------------------------/-- - ' (Plot plan, showing size of lot, location of system in r�fa on to wells, bu•dings, eta, can be placed on reverse side). FOR DEPARTMENT USE ONLY . ' APPLICATION ACCEPTED BY---------------------/.. DATE..--.... --..- '�� -& --- ---- REVIEWEDBY......--'----.................----.........-...... --f--------------------------------- -----...-----------'--- DATE----'-�.. PERMIT ISSUED.-------•..............•---....-•-----........ - ...-----------......-......---......... DATE.------•--------------------------------- BUILDINGAlterations and/or recommendations:.. ---- - .......... -------..... .....-,•.•--------..•-------------------------••........................................ ..... . . .. r 7/ --- _... ............... --._..----................---....-......-•--- .... ...--•- ------- -- -:1' T'`-'---- -°u..:'.....................•-----........... ....._......................------ . ....•--------------------------...............--•---...---------------------....------......------. •----------- ............................ ...... ............... ...... FINAL INSPECTION BY:..........(r/ Date..... \ ... ........ ..... ............ ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soeth American Street 300 Wert Oak Street 124 Sycamore Street 205 Wert 9th Street ' Stockton,California Lodi,California Manteca, California Tracy, California 19-9 9E-1e..9'e9 f.Y.CO.11.1 8'60